NSAID GASTROPATHY - A NEW UNDERSTANDING

Nonsteroidal anti-inflammatory drug (NSAID) gastropathy is associated with substantial morbidity and mortality, which result in high costs t o both the patient and society. The subset of patients who are at grea test risk for developing NSAID gastropathy continues to be better defi ned, but various risk factors, such as age and previous gastrointestin al tract disease, have been identified. In patients receiving older NS AIDs, the choice of NSAID should be based on differences in formulatio ns at the lowest effective dose. Gastroprotective cotherapy should be instituted if treatment with older NSAIDs is continued in at-risk pati ents; misoprostol is currently the only agent approved for this indica tion. The impact of misoprostol on clinical gastrointestinal tract end points has recently been documented. Newer NSAIDs may have an improve d safety profile over older NSAIDs; some have a clinically documented reduction in the incidence of adverse gastrointestinal tract effects, An understanding of these issues should enable the informed clinician to choose an NSAID on the basis of risk-benefit and cost-benefit consi derations.